1 Out Of 5 Medical Claims Processed Incorrectly, Says AMA

Maybe you’re reading this on your iPhone while sitting in your doctor’s waiting room. If so, look around you. Because one out of the five of you in the room will have your claim processed incorrectly by your insurance company.

According to the a report released this morning by the American Medical Association, 20% of medical claims get screwed up somewhere in the well-oiled machine that is the health insurance industry.

The AMA looked at the seven biggest insurance providers in the U.S. and checked out both the timeliness and accuracy of their claims processing. There results: the industry averaged an 80% “accuracy rate for processing and paying claims.”

All of these errors add up to a loss of billions to the health care industry, says the AMA.

The most accurate insurance company in the study was Coventry Health Care, Inc., with an accuracy rating of 88.41%. Health Care Service Corp. was second, with an 87.83% rating.

Not surprisingly, Anthem Blue Cross Blue Shield brought up the rear with a sad 73.98% accuracy rating. Maybe that’s why they need to raise rates on policyholders in California — to cover their losses from incompetence.

Here’s how a bigwig from the AMA puts their findings:

The finding that one in five medical claims are processed by insurers with errors emphasizes the huge potential for reducing administrative costs for physicians and insurers… Creating a single transparent set of processing and payment rules for the health insurance industry would create system wide savings and allow physicians to direct time and resources to patient care and away from excessive paperwork.

AMA meeting: 20% of claims not processed right [ChicagoBreakingNews.com]

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